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Wednesday, June 24, 2015

Telemedicine in veterinary practice

No, we're not making a movie. We're practising teledermatology on a dog with chronic pododermatitis.

Telemedicine is a rapidly growing area in human medicine,
and it was mentioned at the Pan Pacific veterinary conference as a technology we will
see more of in the future.

In case you didn’t know, telemedicine is basically the
use of technology (computers, cameras, internet) to provide health care from a
distance.

In human medicine it’s used for city-based specialists to
log in and assess patients who are in rural and remote areas, for example. You
might also use it to assess patients you can’t have contact with (for example,
those in isolation, those that have been treated with radioactive substances
and so on). Doctors are using terms like “teledermatology”, “telecardiology”
and “telepsychiatry”. The idea is patients have increased access to
specialists, doctors (especially those that are isolated) have better support,
and there are other potential applications like education.

Is there a place for telemedicine in veterinary medicine?
To some extent it’s already done in some large organisations and it has been
argued by some authors that since the advent of computers veterinarians have
practiced an informal telemedicine among themselves.

But given its success in the human field, manufacturers
are listening to vets. For example, in the human health care sitting it’s
acceptable to have the camera mounted in one place.

That’s a bit harder when you’re examining patients that
range anywhere from less than 1kg to almost 100kg (my largest patient ever weighed
94kg). You have to be able to adjust those things! Sony has now developed a sturdy stand so you can move the camera
around – and it’s strong enough not to be knocked over by rowdy patients.

Of course the first time one gets hold of new technology like this one wants to examine one's own dog! The smart phone tends to crap out when you get too close, but this technology allows me (or any interested party with access) to go extreme close up on his problematic nose - without getting in his face.

I struggled initially seeing the difference between
telemedicine, a more expensive technology, and use of a smartphone or tablet to
do the same thing.

But there are some key differences.

Telemedicine units are
designed to maintain privacy and security. You can’t access the system unless
you are authorised to do so.

As you might expect, the resolution is much higher and it
utilises optical zoom (the unit we saw demonstrated uses 36x optical zoom) –
you could have a remote specialist, for example, zooming in on tiny nodule or
distichia. And it can also be used to view equipment in the room – from anaesthetic
machines to ECGs and radiographs (though hopefully you can email those to a
specialist).

Unlike skype or facetime or whatever program or app you
use, the telemedicine unit is controlled by the person logging in at the other
end and the camera moves around, so they can zoom in and out on different parts
of the animal.

While I think this technology is unlikely to be taken up
in inner city practices where nearby specialists abound, I can see potential
veterinary applications.

While they can’t dive in and ligate a bleeding artery for
you, a specialist surgeon could log in and talk you through a difficult
surgery. This would be extremely useful and potentially life-saving in rural
and remote areas.

Assessing the behaviour of patients that have already had
medical complaints ruled out. There are behaviour specialists located in most
cities now but people in remote areas have to travel a long way – and often can’t
– for the benefit of their advice. Being able to see the patient interact with
the owners and clinician and take a behavioural history may be valuable in
these cases.

Monitoring herd health between farm visits. Pig, poultry,
sheep and cattle vets often have clients that are located very far apart. Being
able to more accurately assess the herd will ensure that their health and
welfare is maintained between visits.

There may be specialists who just do telemedicine. They may be retired or unable to visit practices for other reasons (e.g. a medical condition, kids at home, being a full-time carer etc.) and this sort of working situation may suit them very well.

Of course you need a system where speciaists are available and prepared to help at the other end, and clients would need to pay an appropriate fee to cover costs of the specialists and the use of the technology.

The obvious downside is the specialist or consultant can't touch the animal, either for the purposes of examination or treatment (you can't palpate an abdomen without putting your hands on that abdomen) - nor can they deliver a liver treat. Telemedicine will never replace hands on practice.

It will be interesting to see how this technology is used
by veterinarians in Australia and what systems it is built into.

According to one review on the subject,

Telemedicine is not a technology, a separate branch of
medicine, a new branch of medicine, the preserve of computer nerds, or a mature
discipline. It is an evolving field. Telemedicine will in time become an integral
part of the practice of certain aspects of veterinary medicine. It is not a matter
of it, but when (Mars & Auer, 2006).

Veterinary Ethics: Navigating Tough Cases

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